cdc.gov/coronavirus

Dana Meaney-Delman, MD, MPH FACOG

Lead, Maternal Immunization

ACIP Meeting

September 22, 2021

Updates on COVID-19 and Pregnancy

CDC Coronavirus Disease 2019 Response
Disclaimer

 The findings and conclusions in this report are those of the authors and do 

not necessarily represent the official position of the Centers for Disease 

Control and Prevention (CDC).

 Mention of a product or company name is for identification purposes only and 

does not constitute endorsement by CDC.

2
COVID-19 epidemiology among pregnant people
Pregnant people with laboratory-confirmed SARS-CoV-2 infection 

(National COVID-19 Case Surveillance Data)*

National COVID-19 case surveillance data: Pregnant people with laboratory-confirmed SARS-CoV-2 infection,* Jan 22, 2020–Sep 13, 2021

* Based on detection of SARS-CoV-2 in a clinical specimen by molecular amplification techniques https://covid.cdc.gov/covid-data-tracker/#pregnant-population
COVID-19 cases, ICU admission and death among pregnant people

(National COVID-19 Case Surveillance Data; Jan 22, 2020 – Sep 13, 2021)

0

10

20

30

40

50

60

70

80

90

100

0

2000

4000

6000

8000

10000

12000

14000

16000

Total ICU admission or deaths

Total laboratory-confirmed cases

ICU admission (n)

Death (n)

Total pregnant women people
Severe illness and adverse maternal, pregnancy, and neonatal 

outcomes among pregnant women with COVID-19

Data from Allotey, J et al. unless otherwise noted; *Women of reproductive age; ** Preeclampsia data from Wei et al.; ECMO: Extracorporeal membrane oxygenation

Compared with non-pregnant WRA* with COVID-19

Compared with pregnant women without COVID-19

Odds Ratios 

[95% CI]

10,184 / 601,108

3,550 / 601,044

137 / 461,936

Number of 

events / Total

2.13 (1.93-2.95)

2.59 (2.28-2.94)

2.02 (1.22-3.34)

16 / 4,820

28,326 / 424,344

719 / 8,549

35 / 5,794

848 / 5,873

2.85 (1.08-7.52)

1.33 (1.03-1.73)

1.47 (1.14-1.91)

2.84 (1.25-6.45)

4.89 (1.87-12.81)

Odds Ratios 

[95% CI]

Number of 

events / Total

0 2 4 6 8 10 12 14

NICU admission

Stillbirth

Preterm birth

Preeclampsia**

Maternal death

0 2 4 6 8 10 12 14

ECMO

Invasive ventilation

ICU admission
Outcomes of Interest

No. (%)*

Crude RR 

(95% CI)

aRR 

(95% CI) †

Symptomatic 

Pregnant women 

with COVID-19

Symptomatic 

Nonpregnant women 

with COVID-19

(N = 23,434) (N = 386,028)

ICU Admission 245 (1.1) 1,492 (0.4) 2.7 (2.4-3.1) 3.0 (2.6-3.4)

Mechanical Ventilation 67 (0.3) 412 (0.1) 2.7 (2.1-3.5) 2.9 (2.2-3.8)

ECMO§ 17 (0.1) 120 (0.0) 2.3 (1.4-3.9) 2.4 (1.5-4.0)

Death 34 (0.2) 447 (0.1) 1.3 (0.9-1.8) 1.7 (1.2-2.4)

Severe illness and death for symptomatic pregnant women 

with COVID-19 compared to symptomatic nonpregnant women

* Percentages calculated among total in pregnancy status group; those with missing data on outcomes were counted as not having the outcome

† Adjusted for age, race/ethnicity, and presence of underlying conditions. Nonpregnant women are the referent group.

§ Extracorporeal membrane oxygenation

Zambrano LD, Ellington S, Strid P, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by 

Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep. ePub: 2 November 2020. 

DOI: http://dx.doi.org/10.15585/mmwr.mm6944e3external icon.
1. Data from Surveillance for Emerging Threats to Mothers and Babies Network https://www.researchsquare.com/article/rs-491688/v1

2. Mullins E, Hudak ML, Banerjee J, et al. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol. 2021;57(4):573-581. 

doi:10.1002/uog.23619

Perinatal infection among neonates born to pregnant women 

with SARS-CoV-2 infection1

 25,896 live born infants had ≥1 neonatal 

SARS-CoV-2 PCR test; 3,381 (13%) underwent 

PCR testing during the perinatal period 

 136 (4%) of those tested were PCR-positive

– Nearly all were born to mothers with 

infection close to delivery (<14 days)

– Positivity higher among those born preterm

 Other cohorts have estimated perinatal 

positivity to be 1-2%2
COVID-19 vaccine effectiveness in pregnancy
Early data suggest receiving an mRNA COVID-19 vaccine during 

pregnancy reduces the risk for infection

 Two Recent Studies from Israel 

– Objective: Assess the association between receipt of 

mRNA COVID-19 vaccine and risk of infection among 

pregnant people

 Methods:

– Retrospective cohort studies leveraging large statemandated health care organizations 

– Vaccinated pregnant people were 1:1 matched to 

unvaccinated pregnant people by demographic and clinical 

characteristics

https://jamanetwork.com/journals/jama/fullarticle/2782047

https://www.nature.com/articles/s41591-021-01490-8
Early data suggest receiving an mRNA COVID-19 vaccine 

(BNT162b2) during pregnancy reduces the risk for infection

Goldshtein et al. 

 7,530 vaccinated pregnant 

people and 7,530 

unvaccinated pregnant people

 Vaccination with mRNA 

COVID-19 vaccines lowered 

the risk of infection among 

pregnant people

Cumulative incidence of SARS-CoV-2 infection over time

https://jamanetwork.com/journals/jama/fullarticle/2782047
Receipt of an mRNA COVID-19 vaccine (BNT162b2) during 

pregnancy reduces the risk for infection

Dagan et al. 

 Observational cohort: 10,861 

vaccinated pregnant people 

and 10,861 unvaccinated 

pregnant people matched 1:1

 Vaccination with mRNA 

COVID-19 vaccines lowered 

the risk of infection among 

pregnant people

Cumulative incidence of SARS-CoV-2 infection over time

(Time since 2nd dose)

https://www.nature.com/articles/s41591-021-01490-8
Vaccination during pregnancy: Studying protective effects on 

neonates

National Institutes of Health begins study of 

COVID-19 vaccination during pregnancy and 

postpartum: MOMI-VAX

Researchers will evaluate antibody responses in 

vaccinated participants and their infants

• 750 pregnant individuals and 250 postpartum 

individuals 

• Participants and their infants followed 

through the first year after delivery

• Antibody testing on umbilical cord blood, 

breast milk and blood from infants two and 

six months after delivery 

• COVID-19 mRNA vaccination generated 

robust humoral immunity in pregnant and 

lactating women

• Immunogenicity and reactogenicity similar to 

that observed in nonpregnant women

• Vaccine-induced immune response were 

significantly greater than the response to 

natural infection

• Immune transfer to neonates occurred via 

placenta and breastmilk

https://pubmed.ncbi.nlm.nih.gov/33775692/
COVID-19 vaccination in pregnancy: 

Updated clinical considerations 
Updated clinical considerations: 

COVID-19 vaccination during pregnancy and lactation

 COVID-19 vaccination is recommended for all 

people aged 12 years and older, including

people who are pregnant, breastfeeding, or 

who trying to get pregnant now or might 

become pregnant in the future.

 Consistent with recommendations from 

professional medical organizations

https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccinesus.html#pregnant
Summary: Evidence indicates benefits of COVID-19 vaccination 

during pregnancy outweigh potential risks

Pregnancy increases the risk for severe illness and death 

from COVID-19 and COVID-19 is associated with adverse 

maternal, pregnancy and neonatal outcomes

Data on the safety of receiving mRNA COVID-19 vaccine 

during pregnancy are reassuring

Receipt of an mRNA COVID-19 vaccine during pregnancy 

reduces the risk for infection

Vaccination during pregnancy results in maternal antibodies 

that have been detected in infant cord blood

Vaccination coverage for pregnant people is low

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/planning-for-pregnancy.html
COVID-19 vaccination coverage among pregnant people

Percent of pregnant people aged 18–49 years fully vaccinated with COVID-19 vaccine 

prior to and during pregnancy, by timing of vaccination and date reported to CDC—

Vaccine Safety Datalink, United States, December 14, 2020–September 11, 2021

https://covid.cdc.gov/covid-data-tracker/#vaccinations-pregnant-women ; ACOG: American College of Obstetricians and Gynecologists; SMFM: Society for Maternal-Fetal Medicine

Updated ACOG/

SMFM Guidance 

Updated CDC 

Clinical Considerations 

COVID-19 

vaccines available 

to all individuals 

16+ years

Overall coverage: 30.1%
CDC efforts to improve vaccination coverage for pregnant people

• Monitor and display trends 

• Assess reasons for vaccine hesitancy and share 

personal stories

• Disseminate safety information 

• Work with clinical organizations and encourage 

more clinicians to become a vaccine provider*

• Provide resources to assist with vaccine 

discussions

• Ensure consistent messaging about COVID-19 

vaccination for pregnant people 

• Dispel myths about vaccine

*Resources to enroll as a vaccine provider: https://www.cdc.gov/vaccines/covid-19/provider-enrollment.html 
Acknowledgments

 Kara Polen

 CDC’s COVID-19 Response:

– Maternal Immunization Team

– Pregnancy and Infant Linked Outcomes Team

– Vaccine Task Force

 Advisory Committee on Immunization Practices

 CDC’s National Center on Birth Defects and Developmental Disabilities

 CDC’s Division of Reproductive Health

 CDC’s National Center on Immunization and Respiratory Diseases

 State and Local Jurisdictions

 Clinical and Public Health Partners

 Healthcare Providers and Pregnant Persons

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The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.